Foot and Ankle Fractures

Condition

A “fracture” is the technical term for a “broken bone,” which is a crack in the bone. In fact, the two terms can be used interchangeably. Bones break, or fracture, in two settings: with a significant amount of force, (as in the case of a twisting injury when the ankle bones fracture or a car accident when bones in the foot may break), or when a small or moderate amount of force is applied over and over again to a specific bone. The first type is also called a “traumatic fracture,” while the second type is called a “stress fracture.” Most commonly, the bone breaks but does not shift position (i.e. does not “displace”).

Athletes can get fractures in many locations, including the small bones in the feet.

A Jones fracture is a fracture at the base of 5th metatarsal (the long bone on the outside of the foot). These fractures commonly occur from twisting forces on the foot and can occur suddenly with an acute fracture or slowly over time as a stress fracture. Either way, these fractures cause pain and swelling on the outside of the mid-foot. Any weight bearing is painful, making it almost impossible to run, let alone cut or change direction. The fracture occurs at a part of the bone that has a limited blood supply, and this can affect healing as described below.

Jones fractures can occur to people in all walks of life. For most people, these fractures don’t need surgery. If this type of fracture is treated without surgery, the patient has to wear a special boot and walk with crutches to take stress off of the fracture and protect it while it heals, which may take at least six to eight weeks. However, sometimes the bone shows signs of delayed or non-union (non-healing), even after several months of treatment. This can usually be attributed to a poor blood supply to the area. In these cases, surgery may be necessary. This usually involves placing a special screw across the fracture, with the occasional addition of a bone graft, which acts to stimulate new bone growth.

When a high performance athlete has this type of fracture, they often undergo surgery right away. Obviously, they want to get back to competition as soon as possible, but waiting to see if the fracture heals may require more time than they’re willing to give. Therefore, they undergo surgery to stabilize the fracture, with or without bone graft. In order to speed up healing, in addition to a bone graft, a bone stimulator is used, supplying a weak electric current across the fracture site to encourage bone healing. Even with surgery, patients must wear a special boot and crutches to protect the fracture in the early healing phase.

Stress fractures are analogous to bending a paper clip. If you gently bend a paper clip a single time, it will not break. However, if you continue to bend it back and forth, over time it weakens and eventually breaks. This weakening of bone (also called “fatigue”) is technically called a “stress reaction.” When the bone goes on to actually break, it becomes a stress fracture.